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Arizona rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.12 / $1,076.47 / $1,076.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.33 / $125.54 / $516.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.94 / $216.55 / $391.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.86 / $199.81 / $272.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $130.59 / $130.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.33 / $130.59 / $195.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.31 / $130.60 / $1,089.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.15 / $104.27 / $157.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.15 / $104.27 / $157.07